This handout is for delirium (older adult). Your care team identified this based on: acute confusion / new disorientation / "not themselves" reported by family or staff (nice cg103 2023).
Other reasons your team may use this plan: fluctuating attention or level of consciousness — positive cam / 4at screen (inouye ann intern med 1990); new agitation (hyperactive) or new lethargy/withdrawal/somnolence (hypoactive — most missed) in older inpatient (dsm-5-tr); age >=65 post-operative or post-acute-illness cognitive change — postoperative delirium screen (ags/ads 2015).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| treat_precipitant_infection_metabolic_hypoxia_retention_pain | — | — | — | NICE CG103 2023 — delirium is the surface sign of an acute insult; targeted treatment of infection, metabolic derangement, hypoxia, retention and pain is the definitive therapy and outperforms any drug |
| empiric_thiamine_before_glucose | — | — | — | AGS/ADS 2015 — IV thiamine 500 mg before any glucose load when Wernicke is possible; glucose without thiamine can precipitate irreversible Wernicke-Korsakoff |
Plan: Delirium — cause-first ladder (treat precipitant -> HELP non-pharm FIRST -> deprescribe -> targeted pharmacologic ONLY for dangerous agitation -> withdrawal/Wernicke -> ICU dexmedetomidine)
Call 911 or go to the nearest emergency room right away if you have:
Document the delirium episode and resolution status; explicit cognitive follow-up because delirium predicts new/accelerated dementia, functional decline and mortality; medication reconciliation with deprescribing carried forward; carer education + return precautions; outpatient cognitive (MoCA) reassessment once acute illness resolved (AGS/ADS 2015)
Guideline: NICE CG103 Delirium (2023 update) + 2024-2025 delirium reviews; AGS/American Delirium Society; DSM-5-TR